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- Presentation
Quick Dermatologic Surgery Tips for Non-Mohs Surgeons
Description
This talk offered quick dermatologic surgery tips for non-Mohs surgeons, aiming to improve efficiency and outcomes. Key advice included marking excisions directly on the patient and photographing them for documentation, placing scars along relaxed tension lines or within cosmetic subunits when possible, and carefully managing cysts and lipomas with smaller incisions, punctum removal, and awareness of dead space. The speaker emphasized using drains for cysts or lipoma cavities to prevent fluid accumulation and hematoma, and suggested simple drain techniques such as using a sterile glove. For scalp procedures, she recommended avoiding hair cutting when possible, using staples, and using blue Prolene for easier visualization. She stressed being cautious when lesions seem atypical, knowing personal limits, and being prepared for bleeding or syncope with proper setup, cautery, and extra help. The talk also covered cost-conscious suture selection, using generic or gut sutures when appropriate, and adapting closure techniques for thin, atrophic skin with Steri-Strips or glue. Finally, she highlighted the importance of clear verbal and written post-op instructions, follow-up calls, and conversational “talkesthesia” to help patients stay calm during procedures.
View moreConclusions
- Careful preoperative marking along relaxed skin tension lines and cosmetic subunits improves scar placement and cosmetic outcomes.
- Small, targeted incisions that preserve punctum/sac integrity when possible can make cyst and lipoma excisions more efficient and less invasive.
- Dead space management is critical after soft tissue excisions, and drains or other closure strategies can reduce fluid accumulation, bleeding, and infection risk.
- Scalp surgery is often faster and cleaner when hair is not cut, staples are used when appropriate, and closure is optimized for the galea rather than superficial deep sutures.
- Unexpected lesions or atypical presentations should prompt caution and a lower threshold to stop, reassess, or refer rather than proceeding with routine excision.
- Good preparation, hemostasis readiness, and extra assistance help prevent common intraoperative problems such as bleeding and vasovagal events.
- Using the most practical and cost-effective suture materials, including generics or absorbable options when appropriate, can reduce expense without compromising outcomes in selected cases.
- Thin or atrophic skin may benefit from reinforcement with Steri-Strips and parallel support to prevent sutures from tearing through fragile tissue.
- Clear verbal and written postoperative instructions, plus a follow-up phone call after bandage removal, improve patient understanding and aftercare compliance.
- Overall, efficient dermatologic surgery depends on combining technical pearls with simple workflow habits that improve safety, healing, and patient satisfaction.
- Peterson S., Chilukuri S., Goldberg L., Joseph A. (2003). Surgical pearl: use of sterile glove finger as a surgical drain. Pgs. 902-903.#10.1016/s0190-9622(03)02124-8
- Gillanders et al. (2018). Plastic & Reconstructive Aesthetic Surgery review.